A Discordant Pattern of Uptake on 68Ga-PSMA PET/CT Versus 18F-Fluciclovine PET/CT in Radiation-Induced Hepatitis

Adediran, Omotayo A.; Lawal, Ismaheel; Muzahir, Saima; Bhave, Manali; Friend, Sarah; Fielder, Bridget; Meisel, Jane L.; Torres, Mylin A.; Styblo, Toncred M.; Graham, Cathy L.; Holbrook, Anna I.; Kalinsky, Kevin; Crowe, Ronald J.; Ulaner, Gary A.; Schuster, David M.

doi:10.1097/rlu.0000000000004565

Cited by 5 publications

(5 citation statements)

References 8 publications

(14 reference statements)

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“…However, reports of increased PSMA uptake due to hepatitis are rare. In a case report published by Adediran et al increased uptake on Ga68-PSMA PET/CT due to radiation hepatitis in the liver dome after radiotherapy in a patient diagnosed with invasive lobular carcinoma of the right breast (27). In our study, one patient with false positive liver uptake had histopathological con rmed cholestatic hepatitis.…”

Section: Discussionsupporting

confidence: 60%

The Role of Ga⁶⁸-PSMA PET/CT in restagingof biochemical recurrent prostate cancer after radical prostatectomy and/or radiotheraphy

Dündar,

Bural,

Boz

2024

Preprint

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Introduction: The aim of our study was to investigate the the diagnostic performance of PSMA PET/CT performed for restaging in subjects with biochemical recurrent prostate carcinoma after curative treatment either with radical prostatectomy (RP) or Radiation Treatment (RT). Method 58 prostate cancer patients (Age 73 ± 8) with biochemical recurrent prostate carcinoma after curative Treatment (with RP or RT) who underwent Ga68-PSMA PET/CT between December 2015 and August 2022 were retrospectively analyzed. PSMA uptake levels were grouped as posivite or negative. Positive disease locations were classified as prostate/prostate bed, pelvic lymph node, abdominal lymph node, supradiaphragmatic lymph node, bone, visceral organ. SUVmax values were recorded for positive disease sites. According to PSMA PET/CT findings, the extent of disease was decided (pelvis limited and distant metastatic). Gleason score, ISUP grade (International Society of Urological Pathology)), PSA, PSAdt, PSAvelocity and pathological SUVmax values were recorded and compared in PET positive and negative subjects and also in RT and RP groups. Findings were correlated with histopathological results and /or radiological, clinical and laboratory findings. Results PSMA PET/CT was positive in 33 patients, negative in 25 patients. The sensitivity, specificity, positive predictive value and negative predictive value of PSMA PET/CT were calculated as 73.2%, 78.6%, 90.9%, 50%, respectively. Patient-based detection rate was found to be 57%. Detection rate was 24% when PSA level was < 1 ng/ml, 69% when PSA level was between 1–4 ng/ml and 81% when PSA level was above 4 ng/ml. A statistically significant correlation was found between Ga68-PSMA PET/CT positivity and age, Gleason score, ISUP grade and PSA level. PSA value was found to be significantly higher in PET-positive patients. The threshold value in the ROC analysis for PSA was calculated as 1.0050 ng/ml, and was statistically significant (p = 0.06).In the presence of bone involvement, Gleason score average and PSA were found to be higher. A statistically significant relationship was found between visceral involvement, supradiaphragmatic LN involvement and bone involvement and ISUP Grade categories. A statistically significant strong positive correlation was observed between PSA and bone SUVmax. PSA value was observed to be significantly higher in patients with distant metastases. It was noted that the PSAdt value was shorter, especially in cases with extensive metatatic disease. The uptake in local recurrence site was higher in subjects who had RT than in subcets with RP. No difference was noted for both groups in other metastatic disase sites. Conclusion Ga68-PSMA PET/CT has shown reliable performance in locating recurrence sites of prostate cancer. This performance is better when the PSA serum level is above 1 ng/mL. Ga68-PSMA PET/CT imaging should be considered and used as the first-line imaging modality for biochemical recurrence in prostate cancer patients who had curative treatment.

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Section: Discussionsupporting

confidence: 60%

The Role of Ga⁶⁸-PSMA PET/CT in restagingof biochemical recurrent prostate cancer after radical prostatectomy and/or radiotheraphy

Dündar,

Bural,

Boz

2024

Preprint

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“…Only 1 other case to of probable radiation-induced hepatic injury demonstrating PSMA activity has been reported. 13 Multiple studies have shown significant FDG uptake in radiation-induced liver injury, attributed to heightened glucose uptake by leukocytes in the inflammatory process. Recently newer tracers such as 18 F-FAPI and now PSMA have been shown to demonstrate increased uptake with concurrent absent or normal FDG uptake in radiation-induced liver injury.…”

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confidence: 99%

“…The discordance between PSMA and FDG uptake in the affected liver region is of interest, possibly indicating PSMA expression in the chronic phase of fibrotic tissue remodeling. Only 1 other case to of probable radiation-induced hepatic injury demonstrating PSMA activity has been reported 13 . Multiple studies have shown significant FDG uptake in radiation-induced liver injury, attributed to heightened glucose uptake by leukocytes in the inflammatory process.…”

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confidence: 99%

Hepatic PSMA-Avid Postradiation Inflammation

Silveira,

Razmaria,

Yeh

2024

Clin Nucl Med

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A 62-year-old man with de novo large volume metastatic prostate cancer to the bone, liver, and nodes status post multiple lines of therapy including external beam radiation to T12–L2 approximately 13 months prior underwent 68Ga-PSMA PET/CT to determine eligibility for 177Lu-PSMA therapy. 68Ga-PSMA PET/CT demonstrated tracer-avid osseous and nodal lesions consistent with metastases. In addition, regional geographic tracer avidity was seen in the midline left hepatic lobe associated with capsular retraction and demonstrated no FDG avidity on subsequent imaging, probably inflammatory related to prior radiation to T12–L2.

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“…Avidity on PSMA-targeted PET imaging has been widely reported in multiple nonprostate neoplastic and nonneoplastic conditions, including cancer therapy-related injuries. [1][2][3] Prostate-specific membrane antigen avidity due to aberrant vascular anatomy has not been widely reported. This case highlights many important lessons, including the consistency of this artifactual uptake with different PSMA-targeting radiopharmaceuticals and across different imaging techniques.…”

mentioning

confidence: 99%

“…The coronal postcontrast T1FS sequence ( D ) demonstrates the aberrant vessel arising from the duodenum/pancreatic head and terminating within hepatic segment IV ( D , arrows). Avidity on PSMA-targeted PET imaging has been widely reported in multiple nonprostate neoplastic and nonneoplastic conditions, including cancer therapy–related injuries 1–3 . Prostate-specific membrane antigen avidity due to aberrant vascular anatomy has not been widely reported.…”

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confidence: 99%

Aberrant Vascular Anatomy Associated With Artifactual Focal Avidity in the Liver on PSMA PET

et al. 2023

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68Ga–prostate-specific membrane antigen (PSMA) PET/CT is a valuable tool for staging and restaging of prostate cancer. Prostate-specific membrane antigen expression is not specific to prostate cancer, as it is expressed in normal tissues as well as in neoplastic and nonneoplastic processes. Awareness of the broad possibility of lesions with PSMA avidity is necessary to recognize normal variants and avoid potential pitfalls in image interpretation. We present a series of cases showing physiologic focal PSMA avidity in hepatic segment IVb. We correlate this uptake with aberrant hepatic vasculature. The awareness of this variant is important for accurate image interpretation to prevent additional invasive procedures, undue treatment escalation, and denial of curative treatment to patients.

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A Discordant Pattern of Uptake on 68Ga-PSMA PET/CT Versus 18F-Fluciclovine PET/CT in Radiation-Induced Hepatitis

Cited by 5 publications

References 8 publications

The Role of Ga⁶⁸-PSMA PET/CT in restagingof biochemical recurrent prostate cancer after radical prostatectomy and/or radiotheraphy

The Role of Ga⁶⁸-PSMA PET/CT in restagingof biochemical recurrent prostate cancer after radical prostatectomy and/or radiotheraphy

Hepatic PSMA-Avid Postradiation Inflammation

Aberrant Vascular Anatomy Associated With Artifactual Focal Avidity in the Liver on PSMA PET

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